Healthcare Provider Details

I. General information

NPI: 1275008211
Provider Name (Legal Business Name): MELISSA KAY RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MAIN ST
SPRING VALLEY NY
10977-4020
US

IV. Provider business mailing address

230 N MAIN ST
SPRING VALLEY NY
10977-4020
US

V. Phone/Fax

Practice location:
  • Phone: 845-363-8140
  • Fax:
Mailing address:
  • Phone: 845-363-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number708211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: